A Multi-Clinic Study: Patients’ Preferred Versus Perceived Involvement in Decision-Making Among OBGYN Specialties

INTRODUCTION: Studies have shown up to a 40% discordance between patients' preferred roles in decision-making and their perceived roles after a physician encounter. This phenomenon can negatively impact patients' experiences within healthcare. Few studies have evaluated this potential discordance among OBGYN specialties. OBJECTIVE: We compared patients' preferred role in medical decision-making to their perceived role after their initial visits to a urogynecology or oncology clinic or first encounter to labor and delivery. METHODS: This prospective, multi-clinic, cohort study enrolled adult English-speaking women presenting for their initial visit to urogynecology or gynecology oncology clinics or to labor and delivery. Prior to their visit, participants completed the Control Preference Scale (CPS), which categorizes the role that patients want to have in medical decision-making: active, collaborative, or passive. Patients also completed a post-visit CPS to rate their actual role in medical decision-making and the Short Test of Functional Health Literacy in Adults questionnaire. Univariable and multivariable generalized estimating equations were used. RESULTS: 398 women participated in this multi-clinic study. Approximately half of the patients (N=398) were seen in labor and delivery (n=206 or 51.8%) with the remaining patients seen in either urogynecology (n=100 or 25.1%) or oncology clinics (n=92 or 23.1%). Among patients reporting their race (n=376 or 94.5%), most identified as White (n=272 or 72.3%) or Black (n=77 or 20.5%); few self-identified as Asian (n=12 or 3.2%) or other race (n=15 or 4.0%). Among patients reporting their education (n=374 or 94.0%), most reported having at least some college (n=101 or 27.0%), graduating from college (n=106 or 28.3%), or receiving graduate school training (n=91 or 24.3%); few reported only achieving a high school level education (n=70 or 18.7%) or fewer than 12 years of study (n=6 or 1.6%). Regarding patients’ CPS responses, most women preferred an active (n=255 or 66.4%) or collaborative involvement (n=104 or 27.1%) in medical decision-making; few preferred passive involvement (n=25 or 5.6%). After the visit or delivery, women rated their actual role in medical decision-making as different from their preferences (p=.005), with 59.9% of women rated their actual role as active, 29.5% as collaborative, and 10.6% as passive (Figure 1). In fact, among patients reporting both a pre- and post-CPS response (n=362 or 91.0%), the discordance rate was 28.2% (n=102). Participants’ CPS responses did not depend on their clinic location (p=.85), race (p=.60), or years of education (p=.33). CONCLUSIONS: Regardless of the location where patients were seen, there is a discordance between women’s reported role in medical decision-making and their preferences before the visit, with most patients reporting a less active role compared to their preferences. This did not depend on clinic/subspecialty location, race, or education.